Medication Non-adherence: a Major Cause of Resistant Hypertension
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HYPERTENSION (DS GELLER AND DL COHEN, SECTION EDITORS)
Medication Non-adherence: a Major Cause of Resistant Hypertension S. Mehrdad Hamrahian 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review As the global burden of hypertension continues to rise, it remains suboptimally controlled despite increased awareness. Poor medication adherence is a well-recognized although underestimated contributing factor of uncontrolled hypertension. This review focuses on medication non-adherence as an important cause of apparent treatment-resistant hypertension and its impact on patient’s well-being. Recent Findings In addition to biochemical screening, electronic technology—including electronic medication packaging devices such as medication event monitoring system, device integrated care delivery systems like digital medicine, and blood pressure telemonitoring—provides reliable objective data that enables healthcare providers to make decisions that enhance adherence and improve blood pressure control. Summary Consistent medication adherence is a key factor to sustained blood pressure control. Evaluation and correct assessment for adherence should be an integral part of management of patients with apparent treatment-resistant hypertension. Clinicians need to recognize key clues linked to suboptimal adherence or non-adherence that can result in poor outcomes. Keywords Blood pressure . Cardiovascular disease . Hypertension . Medication adherence . Pseudo-resistant hypertension . Resistant hypertension
Introduction
Resistant Hypertension
Hypertension, a global public health challenge, is the major modifiable risk factor for global burden of cardiovascular disease (CVD) and all-cause mortality worldwide [1]. The prevalence and burden of hypertension is rising globally, especially in low- and middle-income countries, due to the aging population, urbanization, and changes in social and environmental risk factors [2, 3]. Awareness of hypertension and its risks has increased, particularly in high-income countries; however, its treatment and control remain unsatisfactorily low worldwide, particularly in low- and middle-income countries and among minority populations in the USA [4].
Resistant hypertension, defined as uncontrolled hypertension on maximally tolerated doses of three different classes of antihypertensive medications including a diuretic, is not uncommon diagnosis [5]. It is associated with adverse health outcomes, particularly a higher risk of cardiovascular complications [6]. Moreover, effective blood pressure (BP)–lowering treatment with antihypertensive regimen reduces BP-related morbidity and mortality [7, 8]. Identification of true resistant hypertension requires exclusion of secondary causes of hypertension, white coat effect, and pseudo-resistant hypertension secondary to inaccurate BP monitoring and poor medication adherence [9–11]. Undertreatment and non-adherence to antihypertensive therapy are well-recognized but underestimated major barriers to BP control in patien
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